Healthcare Provider Details

I. General information

NPI: 1487284949
Provider Name (Legal Business Name): CHERIE A SAGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

584 NORWICH RD STE 400
PLAINFIELD CT
06374-1727
US

IV. Provider business mailing address

584 NORWICH RD STE 400
PLAINFIELD CT
06374-1727
US

V. Phone/Fax

Practice location:
  • Phone: 860-455-3945
  • Fax:
Mailing address:
  • Phone: 860-455-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8567
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: